This application addresses broad Challenge Area (15) Translational Science and Specific Challenge Topic 15-MH-105, Strategies to support uptake of interventions within clinical and community settings. This application will study an innovative approach to implementing mental health services in child welfare settings to reduce foster children's behavior problems and improve school outcomes. This work will address two critical needs in child mental health services research: (1) the need for empirically-based strategies to successfully implement evidence-based services in urban service settings and (2) the particularly urgent need to implement effective mental health services for foster children, who experience three to four times the rate of mental health problems than in the general population of children (Burns et al., 2004;Leslie et al., 2005). The intervention to be disseminated includes parent management training integrated with structured support of learning at home and in school. The enhanced implementation model proposed in this application uses an adaptation of Rogers'(2003) diffusion of innovation theory, which suggests that intervention uptake is improved by using a structured implementation process and, in particular, using highly influential early adopters of the intervention in efforts for dissemination (Atkins et al., 2008;Rogers, 2003). The caseworkers and clinical social workers ("providers") of 160 foster children with emotional and behavior problems will be randomized to experimental and control conditions. The intervention group will include key opinion leader social workers and foster parent advocates who will target uptake of the intervention at two levels: child welfare providers and foster parents. A key hypothesis of this study is that targeting uptake of interventions through an experimental implementation process will improve intervention uptake and lead to lessened child behavior and school problems relative to a "training as usual" implementation process. All hypotheses will be tested using social network analysis and random effects regression models. This application builds on previous intervention research in child welfare settings that has found that parent management interventions with foster parents volunteering to attend groups are effective in reducing foster children's child behavior problems (e.g., Price et al., 2008;Chamberlain, 2002). In addition, in our recently completed pilot study (NIMH K01 070580) in which we adapted Chamberlain's parent management training materials for use with primarily inner city, African American foster parents, we found that foster parents in an intent-to-treat intervention group reported significantly fewer child behavior problems over time relative to control group foster parents receiving services as usual. In this pilot project, we were able to reach 80% of our selected sample by providing services in both community-based settings and foster homes. Despite the positive outcomes of the intervention and strong foster parent interest, however, little uptake of the intervention occurred by existing bachelor's level providers following our training and in vivo coaching phase. This striking contrast in foster parents'and agency providers'responses to the intervention has created the perfect opportunity to study an innovative implementation process in a short, intense project with the goal of addressing a critical implementation problem in high-need service systems. This application specifically addresses intervention uptake and sustainability by comparing intervention use, fidelity, and child outcomes for an experimental receiving an enhanced implementation strategy vs. a control group receiving standard training. The experimental implementation process will occur in three phases and be examined across 5 time points. In the first 3-month phase of the research, project-hired MSWs and foster parent advocates ("change agents") will be infused into existing agency social work teams to conjointly provide groups and home visits, with shared training and supervision from the research project and agency supervisors and a particular focus on increasing knowledge, exposure, and communication with potential adopters of the intervention. In the second phase, active transfer of the intervention to existing providers will occur, with a particular focus on training key opinion leader providers (KOLs) in effective dissemination of the intervention. In the third phase, agency staff will provide services, with consultation provided only as requested by agency providers. The over 500,000 foster children in the U.S. are among the most vulnerable members of our society. They have significant risks for mental health problems that lead to an extraordinarily high risk for outcomes such as incarceration (27% of boys and 10% of girls) and homelessness (12% of all youth) in young adulthood (Courtney, et al., 2001). The significance of strategies to disseminate effective interventions that interrupt this trajectory is enormous, given the extreme vulnerability of this population and the critical need to change their life chances. PUBLIC HEALTH SIGNIFICANCE: The proposed research will study an innovative approach to implementing mental health services in child welfare settings to reduce foster children's behavior problems and improve school outcomes. This work will address two critical needs in child mental health services research: (1) the need for empirically-based strategies to successfully implement evidence-based services in urban service settings and (2) the particularly urgent need to implement effective mental health services for foster children, who experience three to four times the rate of mental health problems than in the general population of children. This application specifically addresses intervention uptake and sustainability by comparing intervention use, fidelity, and child outcomes for an experimental group receiving an enhanced implementation strategy vs. a control group receiving standard training. The experimental implementation process will occur in three phases and be examined across 5 time points (baseline and 3, 6, 9, and 18 months). The implementation model is based on Rogers'(2003) diffusion of innovation theory, which suggests that intervention uptake is improved by using a structured implementation process and, in particular, using highly influential early adopters of the intervention in dissemination efforts.